Cutting Health Inequities Is Key Challenge, PAHO Report Says

September 21, 1998

WASHINGTON. Sept. 21, 1998--Reducing inequities in health care quality and access must be a key consideration for the countries of the Americas as they make changes in health policies, according to the Pan American Health Organization (PAHO).

"Empirical studies have clearly established that the poorest population groups suffer from the worst health," PAHO says in its new report "Health in the Americas," released today. "Furthermore, there is some evidence that health conditions are better in states where income levels are more equitable."

PAHO says strategies aimed at health promotion and disease prevention are necessary for health improvement in the region. "This implies interventions to improve the standard of living of marginalized populations and to eliminate unnecessary, avoidable, and unjust inequalities in individual and collective health and well-being."

The report notes that most governments in the region have made equity a central issue in health policy, transforming health models to emphasize disease prevention, cure and rehabilitation; coordination of health care programs; intersectoral approaches; and social participation.

Almost all the countries in the Americas have a mix of public and private health services, and while many are looking into new ways to finance health care, "more and more of the countries are recognizing that the public sector should assume responsibility for public goods with a high externality content ... and for ensuring the availability of a basic package of services for all."

Per capita national health expenditure in the Americas varies widely, ranging from $3,858 to $9, according to 1995 figures given in the report. Despite region-wide growth in per capita public spending on social security and education in the first half of the 1990s -- by 50 percent and 24.4 percent, respectively -- Latin America still lags behind industrialized countries in overall public sector expenditure.

For example, social security expenditure in industrialized countries is 15 percent of the gross domestic product, while in Latin America it is about 2.5 percent of the GDP, the report says.

Other health care system reforms aim to redefine the government's role in health care and change the way services are delivered, according to the report. Steps taken on the governmental level include decentralizing management of health care systems and transferring power and resources to the local level; strengthening the ministries of health; and creating basic services packages based on epidemiological profiles and available resources.

Service delivery reforms aim to increase the number and variety of public and private service providers, encouraging competition and allowing a choice of financiers and users. Other reforms restructure public hospitals as independent service enterprises, allowing them to assess productivity and institutional and staff performance, guarantee quality of care and keep costs down.

New technologies are also influential in organizing and operating health care systems, and they have the potential to help achieve universal access and information dissemination, and to foster collaboration among countries in the region, the report says.
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The Pan American Health Organization, an international public health agency which also serves as the regional representative of the World Health Organization, has more than 90 years experience in working to improve the health and living standards of the countries of the Americas. PAHO promotes the primary health care strategy, which reaches people in their communities, as a way to extend health services and increase efficiency in the use of scarce resources.

For Further Information Contact:
Daniel Epstein, tel (202) 974-3459, fax (202) 974-3143, Office of Public Information, PAHO.
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Pan American Health Organization

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